Sinusitis , also known as sinus infection or rhinosinusitis , is an inflammation of the sinus that produces symptoms. Common symptoms include thick nasal mucus, nasal congestion, and facial pain. Other signs and symptoms may include fever, headache, poor sense of smell, sore throat, and cough. The cough often worsens at night. Serious complications are rare. It is defined as acute rhinosinusitis (ARS) if it lasts less than 4 weeks, and as chronic rhinosinusitis (CRS) if it lasts for more than 12 weeks.
Sinusitis can be caused by infection, allergies, air pollution, or structural problems in the nose. Most cases are caused by a viral infection. Bacterial infections can occur if symptoms persist for more than ten days or if a person gets worse after it begins to improve. Recurrent episodes are more likely in people with asthma, cystic fibrosis, and poor immune function. X-rays are usually unnecessary unless a complication is suspected. In chronic cases, confirmatory testing is recommended either with direct visualization or computed tomography.
Some cases can be prevented by hand washing, smoking avoidance, and immunization. Pain killers such as naproxen, nasal steroids, and nasal irrigation can be used to help with symptoms. The recommended initial treatment for ARS is to wait with caution. If symptoms do not improve within 7-10 days or worsen, antibiotics may be used or changed. In those taking antibiotics, either amoxicillin or amoxicillin/clavulanate are recommended first line. Surgery can sometimes be used in people with chronic diseases.
Sinusitis is a common condition. It affects between about 10% and 30% of people every year in the United States and Europe. Women are more often affected than men. Chronic sinusitis affects about 12.5% ​​of people. The treatment of sinusitis in the United States produces more than US $ 11 billion in cost. Unnecessary and ineffective viral sinusitis treatment with antibiotics is common.
Video Sinusitis
Classification
Sinusitis (or rhinosinusitis) is defined as an inflammation of the mucous membranes lining the paranasal sinus and is chronologically classified into several categories:
- Acute rhinosinusitis - New infections that can last up to four weeks and can be symptomaticly divided into severe and not severe. Some use definitions up to 12 weeks.
- Recurrent acute rhinosinusitis - Four or more complete episodes of acute sinusitis occurring within a year
- Subacute rhinosinusitis - Infection lasting between four and 12 weeks, and represents a transition between acute and chronic infection
- Chronic rhinosinusitis - When signs and symptoms last for more than 12 weeks.
- Acute exacerbation of chronic rhinosinusitis - When signs and symptoms of chronic rhinosinusitis worsen, but return to the baseline after treatment
All these types of sinusitis have similar symptoms, and thus are often difficult to distinguish. Acute sinusitis is very common. Approximately ninety percent of adults have developed sinusitis at some point in their lives.
Maps Sinusitis
Signs and symptoms
Headache/face or blunt, constant, or painful pressure around the exposed sinus is common in acute and chronic sinusitis stages. The pain is usually localized to the involved sinus and may worsen when the affected person is bent or when lying down. Pain often starts on one side of the head and continues to both sides. Acute sinusitis may be accompanied by thick nasal mucus that is usually green and may contain pus (purulent) and/or blood. Often local headaches or toothaches are present, and those are the symptoms that differentiate sinus-related headaches from other types of headaches, such as tension and migraine headaches. Another way to distinguish between toothache and sinusitis is that the pain in sinusitis usually worsens by tilting the head forward and with a valsava maneuver.
Infections of the eye socket may occur, which can cause vision loss and are accompanied by severe fever and illness. Another possible complication is bone infection (osteomyelitis) of the forehead and other facial bones - Pott's swollen tumor.
Sinus infection can also cause middle ear problems due to congestion of the nasal passages. This may be indicated by dizziness, "pressure or heavy head", or the sensation of vibration in the head. Post nasal drip is also a symptom of chronic rhinosinusitis.
Halitosis (bad breath) is often expressed as a symptom of chronic rhinosinusitis; However, standard gold breath analysis techniques have not been applied. Theoretically, there are several possible mechanisms of both objective and subjective halitosis that may be involved.
A 2004 study showed that up to 90% of "sinus headache" is actually migraine. Confusion occurs partly because migraine involves activation of trigeminal nerves, which inhibit both the sinus and meninges that surround the brain. As a result, it is difficult to accurately determine the site from which the pain originated. People with migraines usually have no thick nasal secretions that are a common symptom of sinus infection.
By location
There are several paired paranasal sinuses, including the frontal, ethmoidal, maxillary and sphenoidal sinuses. The ethmoidal sinus is further subdivided into the anterior and posterior ethmoid sinus, a division defined as the basal lamella of the middle cone. In addition to the severity of the disease, discussed below, sinusitis may be classified by the sinus cavity it affects:
- Maxillary - may cause pain or pressure in the maxillary area (cheek) (eg, toothache, or headache) (J01.0/J32.0)
- Frontal - may cause pain or pressure in the frontal sinus cavity (located above the eye), headache, especially on the forehead (J01.1/J32.1)
- Etmoidal - may cause pain or pressure pain between/behind the eyes, upper side of the nose (medial canthi), and headache (J01.2/J32.2) Sphenoidal - can cause pain or pressure behind the eyes, but often refers to the skull of the vertex (overhead), above the mastoid process, or the back of the head.
Complications
The proximity of the brain to the sinuses makes the most dangerous sinusitis complications, especially those involving the frontal and sphenoid sinuses, brain infections by invasion of anaerobic bacteria through bone or blood vessels. Abscesses, meningitis and other life-threatening conditions may occur. In extreme cases, the patient may experience mild personality changes, headaches, altered consciousness, vision problems, seizures, coma, and possibly death.
Sinus infections may spread through the anastomosing veins or by direct extension to the closed structure. Orbital complications are categorized by Chandler et al. into five stages according to the severity level (see table). Spreading adjacent to orbit can cause periorbital cellulitis, subperiosteal abscess, orbital cellulitis, and abscess. Orbital cellulitis may complicate acute ethmoiditis if the anterior and posterior thymbophlebitis ethomoid voma allows the spread of infection to the lateral side or ethmoid labyrinth orbitals. Sinusitis may extend to the central nervous system, where it can lead to cavernous sinus thrombosis, retrograd meningitis, and epidural, subdural, and cerebral abscesses. Orbital symptoms often precede the intracranial spread of the infection. Other complications include sinobronkitis, maxillary osteomyelitis, and frontal bone osteomyelitis. Osteomyelitis of the frontal bone is often derived from spreading thrombo-phlebitis. A periostitis of the frontal sinus causes osteitis and periostitis in the outer membrane, resulting in a soft and swollen forehead swelling.
The diagnosis of these complications can be helped by observing localized softness and dull pain, and can be confirmed with CT and nuclear isotope scans. The most common causes of microbes are anaerobic bacteria and S. aureus . Treatments include performing surgical drainage and administration of antimicrobial therapy. Surgical debridement is rarely needed after extended parenteral antimicrobial therapy. Antibiotics should be given for at least 6 weeks. Continuous patient monitoring for possible intracranial complications is recommended.
Cause
Maxillary sinusitis may also be from the teeth ("odontogenic sinusitis"), and is a significant percentage (about 20% of all cases of maxillary sinusitis), given the proximity of the teeth and the sinus floor. The cause of this situation is usually a periapical or periodontal infection of the maxillary posterior tooth, where an inflammatory exudate has eroded through the bone superiorly to flow into the maxillary sinus. After the odontogenic infection involves the maxillary sinus, it may be spread into orbit or into the ethmoid sinus. Complementary tests based on conventional radiological techniques and modern technology can be indicated, based on the clinical context.
Chronic sinusitis can also be caused indirectly through a common but little disorder within the auditory tube or eustachian, which is connected to the sinus and throat cavities. Other diseases such as cystic fibrosis and granulomatosis with polyangiitis may also cause chronic sinusitis. This tube is usually almost parallel to the eye socket but when this occasional hereditary disorder is present, it is below this level and sometimes parallel to the front door of the vestibule or nose.
Acute
Acute sinusitis is usually precipitated by previous upper respiratory infections, commonly from viruses, mostly caused by rhinoviruses, coronaviruses, and influenza viruses, others caused by adenovirus, human parainfluenza virus, human respiratory syncytial virus, enteroviruses other than rhinovirus, and metapneumovirus.. If the infection is from bacteria, the three most common causes are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis . To date, Haemophilus influenzae is the most common bacterial agent that causes sinus infections. However, the introduction of type B (Hib) influenza vaccine has dramatically decreased H. influenza type B infection and now can not be removed H. influenza (NTHI) is mostly seen in the clinic. Other pathogenic bacterial pathogens include Staphylococcus aureus and other streptococcal species, anaerobic bacteria and, more rarely, gram-negative bacteria. Virus sinusitis usually lasts for 7 to 10 days, whereas bacterial sinusitis is more persistent. Approximately 0.5% to 2% of viral sinusitis results in subsequent bacterial sinusitis. It is thought that nasal irritation from blowing the nose leads to a secondary bacterial infection.
Acute episodes of sinusitis can also occur due to fungal invasion. This infection is usually seen in patients with diabetes or other immune deficiencies (such as AIDS patients or transplants on immunosuppressive anti-rejection drugs) and can be life-threatening. In people with type I diabetes, ketoacidosis can be associated with sinusitis due to mucormycosis.
Chemical irritation can also trigger sinusitis, generally from cigarette smoke and chlorine smoke. Rarely, it may be caused by a dental infection.
Chronic
By definition chronic sinusitis lasts longer than 12 weeks and can be caused by many different diseases that share chronic inflammation of the sinuses as a common symptom. Symptoms of chronic sinusitis may include a combination of the following: nasal congestion, facial pain, headache, night cough, minor or controlled advance asthma symptoms, general malaise, green or yellow vaginal discharge, face 'saturation' or 'stiffness' which may worsen when bending, dizziness, toothache, and/or bad breath. Each of these symptoms has several other possible causes, which should be considered and investigated as well. Frequent chronic sinusitis can cause anosmia, the inability to smell objects. In a small number of cases, acute or chronic maxillary sinusitis is associated with dental infection. Vertigo, lightheadedness, and blurred vision are not typical of chronic sinusitis and other causes should be investigated.
The case of chronic sinusitis is subdivided into cases with polyps and cases without polyps. When the polyp is present, this condition is called chronic hyperplastic sinusitis; However, the cause is poorly understood and may include allergies, environmental factors such as dust or pollution, bacterial infections, or fungi (either allergic, infective, or reactive).
Chronic haemosinusitis is a multifactorial inflammatory disorder, not just a persistent bacterial infection. Medical management of chronic rhinosinusitis is now focused on controlling inflammation that affects patients against obstruction, reducing the incidence of infection. However, all forms of chronic rhinosinusitis are associated with sinus drainage disorders and secondary bacterial infections. Most individuals require antibiotics early to clear the infection and intermittently thereafter to treat acute exacerbations of chronic rhinosinusitis.
The combination of anaerobic and aerobic bacteria are detected simultaneously with chronic sinusitis. Also isolated are Staphylococcus aureus (including methicillin resistant S.aureus ) and coagulase-negative Staphylococci and Gram-negative enteric organisms can be isolated.
Efforts have been made to provide more consistent nomenclature for chronic sinusitis subtypes. The presence of eosinophils in the nasal mucus and paranasal sinuses has been shown for many patients, and this has been termed eosinophilic mucin rhinosinusitis (EMRS). The EMRS case may be associated with an allergic response, but allergies are not often documented, so subcategories further become allergic and non-allergic ESR.
More recent, and still debated, developments in chronic sinusitis are the role the fungus plays in this disease. It remains unclear whether the fungus is a definite factor in the development of chronic sinusitis and if they are, what difference may be between those who develop the disease and those who remain symptom free. Antifungal treatment trials have mixed results.
Recent sinusitis theory suggests that it often occurs as part of a disease spectrum that affects the airways ( i.e , the theory of "one airway") and is often associated with asthma. All forms of sinusitis may cause, or become part of, general inflammation of the airways, so other airway symptoms, such as cough, may be related to it.
Smoking and passive smoking are associated with chronic rhinosinusitis.
Pathophysiology
It has been hypothesized that bacterial biofilm infections can cause many cases of chronic sinusitis that are resistant to antibiotics. Biofilms are complex aggregates of extracellular matrix and inter-dependent microorganisms of several species, many of which may be difficult or impossible to isolate using standard clinical laboratory techniques. The bacteria found in biofilms have an antibiotic resistance increased up to 1000 times when compared to free-living bacteria of the same species. A recent study found that biofilms are present in the mucosa of 75% of people who undergo surgery for chronic sinusitis.
Diagnosis
Acute
Health care providers distinguish bacterial and viral sinusitis by waiting vigilantly. If a person has had sinusitis for less than 10 days without symptoms becoming worse, then the infection is considered to be viral. When the symptoms last more than 10 days or worse at that time, then the infection is considered a bacterial sinusitis. Imaging either with X-ray, CT or MRI is generally not recommended unless complications develop. Pain caused by sinusitis is sometimes confused for pain caused by pulpitis (toothache) of the maxillary teeth, and vice versa. Classically, the increased pain when tilting the head forward separates sinusitis from pulpitis.
Chronic
For sinusitis lasting more than 12 weeks, CT scan is recommended. In CT scan, acute sinus secretion has a radiodensity of 10 to 25 Hounsfield (HU) units, but in a more chronic state they become thickened, with radiodensity of 30 to 60 HU.
Nasal endoscopy and clinical symptoms are also used to make a positive diagnosis. Sample tissue for histology and culture can also be collected and tested. Allergic fungal sinusitis (AFS) is often seen in people with asthma and nasal polyps. In rare cases, sinusoscopy may be performed.
Nasal endoscopy involves inserting a flexible fiber-optic tube with light and a camera at the end to the nose to check the nasal and sinus passages. This is generally a really painless (though uncomfortable) procedure that takes between five and ten minutes to complete.
Treatment
The recommended treatments for most cases of sinusitis include rest and drinking enough water to thin the mucus. Antibiotics are not recommended for most cases.
Inhaling low-temperature vapors such as from a hot bath or gargle may relieve symptoms. There is temporary evidence for nasal irrigation. A decongestant nasal spray containing oxymetazoline may provide relief, but these drugs should not be used for more than the recommended period. Longer use may lead to rebound sinusitis. It is unclear whether nasal irrigation, antihistamines, or decongestants work in children with acute sinusitis.
Antibiotics
Most cases of sinusitis are caused by a virus and heal without antibiotics. However, if symptoms do not heal within 10 days, amoxicillin is a sensible antibiotic for first use for treatment with amoxicillin/clavulanate that is indicated when a person's symptoms do not improve after 7 days on amoxicillin alone. However, the 2012 Cochrane review found little benefit between 7 and 14 days, and can not recommend this practice when compared to potential complications and the risk of developing resistance. Antibiotics are specifically not recommended in those with mild/moderate disease during the first week of infection due to side-effects, antibiotic resistance, and costs.
Fluoroquinolone, and newer macrolide antibiotics such as clarithromycin or tetracycline such as doxycycline, are used in those with severe allergies to penicillin. Due to increased resistance to amoxicillin, the 2012 guideline of the Infectious Diseases Society of America recommends amoxicillin-clavulanate as the initial treatment of choice for bacterial sinusitis. The guidelines also recommend against commonly used antibiotics, including azithromycin, clarithromycin, and trimethoprim/sulfamethoxazole, due to increased antibiotic resistance. The FDA recommends the use of fluoroquinolone when other options are available because of the higher risk of serious side effects.
Short-term antibiotics (3-7 days) seem to be as effective as normal longer-course antibiotics (10-14 days) for those clinically diagnosed with acute bacterial sinusitis without severe disease or other complicated factors. IDSA guidelines recommend five to seven days of antibiotics long enough to treat bacterial infections without promoting resistance. The guidelines still recommend children receive antibiotic treatment for ten days to two weeks.
Corticosteroids
For unconfirmed acute sinusitis, intranasal corticosteroids have not been found to be better than placebo either alone or in combination with antibiotics. For cases confirmed by radiology or nasal endoscopy, treatment with corticosteroids alone or in combination with antibiotics is supported. However, the benefits are small.
There is only limited evidence to support short treatment with oral corticosteroids for chronic rhinosinusitis with nasal polyps.
Surgery
For chronic or recurrent sinusitis, referrals to otolaryngologist may be indicated, and treatment options may include nasal surgery. Surgery should only be considered for people who do not benefit from drugs. It is not clear how the benefits of surgery compare to their medical care with nasal polyps because this has been poorly studied.
Maxillary antral wetting involves a sinus prick and rinsing with saline to clear mucus. A 1996 study of patients with chronic sinusitis found that washout did not provide any additional benefit over antibiotics alone.
A number of surgical approaches can be used to access the sinus and this is generally shifted from an external/extrasal approach to intranasal endoscopy. The benefits of functional endoscopic sinus surgery (FESS) is its ability to allow more targeted approaches to exposed sinuses, reduce tissue disruption, and minimize post-operative complications. The use of eluting drug stents such as propel mometasone furoate implants may aid recovery after surgery.
Another treatment developed recently is the balloon sinuplasty. This method, similar to the balloon angioplasty used to "unclog" the heart arteries, utilizes balloons in an attempt to expand the opening of the sinuses in a less invasive manner.
For persistent symptoms and illnesses in treatment-disabled patients and a functional endoscopic approach, older techniques can be used to treat maxillary sinus inflammation, such as Caldwell-luc antrostomy. This surgery involves an incision in the upper gum, opening on the anterior wall of the antrum, removal of the maxillary maxillary sinus mucosa and drainage allowed into the inferior or middle meatus by creating a large window on the nasal lateral wall.
Epidemiology
Sinusitis is a common condition, with between 24 and 31 million cases occurring in the United States each year. Chronic sinusitis affects about 12.5% ​​of people.
Research
Based on the latest theory about the role of fungus can play in the development of chronic sinusitis, antifungal treatment has been used, on a trial basis. These trials have mixed results.
See also
- Mushroom sinusitis
References
External links
- Sinusitis in Curlie (based on DMOZ)
Source of the article : Wikipedia
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